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ACA Repeal and Replace: How Will Chronic Pain Patients Fare?

April 4, 2017
House Republicans have passed a replacement bill to replace the Affordable Care Act. Many patients worry about costs and exceptions about pre-existing conditions. Now the Senate will decide.
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Instead of mandates, the AHCA allows insurers to charge 30% higher premiums for 1 year if customers let their coverage lapse for 63 days or more. This may happen if an individual leaves his job or gets laid off. It also applies to those with pre-existing conditions. While insurance companies could not deny coverage based on an individual’s health status, anyone allowing their coverage to lapse must pay the 30% surcharge, regardless of whether they have a pre-existing condition.

Potential Effects

The “continuous coverage” provision is especially worrisome for chronic pain patients who may lose employment when their condition is not controlled. The requirement to maintain coverage, as well as the proposed freezing of Medicaid enrollment, will disproportionately affect this population.

Whatever changes are adopted, Dr. Gudin said both chronic pain patients and physicians need to have “more skin in the game.”  He said, “Patients are going to have to accept that they need to begin paying for some of their routine care, and physicians will have to accept that all patients need to be treated regardless of their ability to pay."

Commenting on the proposed changes, Barby Ingle, president of the International Pain Foundation and a chronic pain patient herself, is not optimistic. The new plan “is not set up for [chronic pain patients], and our voice is being left out,” she said.

Last updated on: May 9, 2017

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